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Colombo National Hospital a Referral Hospital

by Edward Arambawela

A 1995 study done by a batch of Colombo Medical Faculty students has found the need to change the position of the Colombo National Hospital from its present General to Referral Hospital for the whole country.

In this study published in the Faculty's scientific sessions issue for last year (2002), it has been found that 76 per cent of the interviewed patients had travelled 22 kilometres from their homes to the Colombo National Hospital, bypassing a primary health care institution 2 kilometres away to their homes, to get the same treatment for a disease. In this exercise for travelling they had spent Rs. 13.23 whereas they could have done it with only Rs. 1.23 had they gone to the primary care unit.

Their waiting time to see the doctor in Colombo was one hour and twenty minutes whereas it would have taken them only 8 minutes in the primary care unit.

Based on these findings the study group comprising students C. S. Egodage, and M. H. H. Fernando recommend "The public must be made aware regarding the advantages and the need for a strict referral system, in order to change their attitudes in healthcare seeking behaviour."

Here's the published study report

A comparison of some aspects of health services received by patients attending the outpatient departments of a tertiary care hospital and a primary care hospital.

Fernando JLIN, Egodage CS, Fernando MHH

Medical students of 1994/95 batch, Faculty of Medicine, Colombo.

Objectives: To determine the number of patients who bypass their 'Local Primary Healthcare Centre' and attend the National Hospital of Sri Lanka (NHSL), and to determine which Out Patient Department (NHSL/Peripheral Unit) provides a better service to the patient.

Methodology: A non-interventional, descriptive, cross sectional study was carried out with the participation of 30 randomly selected patients from the Out Patient Departments of NHSL and Peripheral Unit - Nawagamuwa (PU-Ng). Information was gathered by a pre-tested, structured, interviewer administered questionnaire and by non-interventional observation of doctor-patient consultations.

Results: All patients who attended both clinics were either from the lower middle or lower class socio-economic background.

The mean distance travelled to reach the institution was 23 km (NHSL) and 2 km (PU-Ng) (P less than 0.002); mean expenditure on travelling was Rs. 13.23 (NHSL) and Rs. 1.23 (PU-Ng) (P less than 0.002); only 19 per cent of patients attending NHSL-OPD said it is the nearest hospital to them while 76 per cent of patients at PU-Ng said it is the nearest for them. Mean time spent for transportation was 1 h 21 min (NHSL) and 19 min (PU-Ng) (P less than 0.001); mean waiting period pending consultation was 1 h 27 min (NHSL) and 8 min (PU-Ng) (p less than 0.001) mean duration from the time of arrival to time of obtaining drugs was 2 h 4 min (NHSL) and 14 min (PU-Ng) (P less than 0.001); mean duration from the time of leaving home and the time of obtaining drugs was 3 h 25 min (NHSL) and 33 min (PU-Ng) (P less than 0.001); and the mean duration of consultation was 2 min 8 sec (NHSL) and 1 min 40 sec (PU-Ng) (P = 0.024). 32 per cent of patients who attended NHSL-OPD needed further referral to a specialised clinic while 3 per cent of PU-Ng needed the same.

26 per cent of the patients who attend NHSL-OPD needed laboratory investigations in the management of their illnesses while all the patients at PU-Ng were managed without such a need. 42 per cent of patients who attended the NHSL-OPD were managed merely by history and examination (this figure at PU-Ng was 97 per cent). There was no significant difference in the treatment received when patients with common symptoms from the two settings were compared. Also there was no significant difference in the availability of prescribed drugs at the hospital pharmacy in the two settings (p greater than 0.1).

Conclusions: Patients who attend the OPD of NHSL spend significantly more time and money to receive similar treatment for their illness, which was available at the local primary healthcare centre. A significant proportion of patients attending the NHSL-OPD can be managed at the local health centre or a closer district/base hospital.

This preliminary study should be extended to with matched samples involving more primary and tertiary care hospitals for greater accuracy. The public needs to be made aware that health services they receive at primary/first contact level are almost uniform irrespective of the level of the institution.

Primary healthcare institutions should boost the confidence of patients of their area that they provide a service similar to tertiary care centres, despite the lack of sophisticated technology and consultants.

Patients should be discouraged from seeking healthcare at tertiary level without referral from primary care.

The general public must be made aware regarding the advantages and the need of a strict referral system, in order to change their attitudes in healthcare seeking behaviour.

Herbal medicines for the people

Herbal produce used in Ayurvedic medicine

The Sri Lanka Association for the Advancement of Science informs us that at its annual sessions this year a detailed discussion will be held at seminar level on the role of herbal medicines for health.

Billed to speak on this subject at the seminar which is to be held in early December at the SLFI are Prof. Lars Bohlin - Medicinal Plants Importance of Research; Dr. A. Ranasinghe - A Holistic Concept of Mechanisms and Modalities of Ayurvedic Drug Actions; Prof. Ajith Abeysekera - Quality Assurance of Herbal Medicines and Future Prospects; Dr. Devapriya Nugawela - A Commercial Perspective; Dr. K. Balasubramanium - Intellectual Property Rights and Herbal Medicines. The session 1 of this seminar is to be chaired by Prof. Colvin Goonaratna and Prof. Vijaya Kumar.

SLAAS advises those interested to attend this seminar to contact Mrs. Manel Chandrasekera or Miss Lakshmi Sivanathan at the SLAAS 2688740 early, as there will be limited accommodation.

Prof. David Warrel to speak on Integrated Medicine

Prof. David Warrel, Editor of the Oxford Textbook of Medicine will speak on the Role of Integrated Medicine in Health Care, at the 41st anniversary sessions of Medicina Alternativa to be held at the BMICH in Colombo on October 28th. The Medicina Alternativa head Dr. Anton Jayasuriya will also donate 50 acres of land in Kitulgala to prof. Worrel to set up a Herpetology Research Centre.

Among other issues to be discussed at this conference, which is expected to be attended by delegates from 140 countries are - genetically modified food, environmental pollution and health hazards, unethical trade union strikes, ethics of abortion and a world integrated Medical Council.

Honey and longevity

by Dr. R. A. T. Wijesinghe - Chest Physician, Matara

Honey is a sweet, sticky, yellowish fluid made by bees and other insects from nectar collected from flowers. Honey we eat is from the honeycomb. Honeycomb is a structure of hexagonal cells of wax made by bees to store honey and eggs.

Many researchers thought that beekeepers lived a longer life than other people. Russians have done a lot of work to find out influence of honey on longevity.

Euprxia Zoe, a popular Russian lady doctor had recommended consumption of honey to promote long life and health.

Many accounts have appeared in the Soviet literature in recent times about people who have lived to exceptional ages. Almost all these people have been beekeepers or regular consumers of honey. A commemorative stamp had been issued by Russians a few years ago in honour of their beekeepers who lived to be over 120 years.

Ayurvedic Medical practitioners point out that human life may be prolonged if a diet rich in honey is taken regularly.

The most celebrated Greek Physician and philosopher of antiquity Hippocrates (460-367 B.C.) is also believed to have eaten honey regularly and to have lived up to 93 years. There is considerable evidence to show that many centenarians have emerged due to regular consumption of honey. Therefore one is forced to reach the conclusion that regular consumption of honey is likely to promote longevity.

It is believed that consumption of honey plays a significant part in preventing premature death. One of the main causes of premature death in man today is cancer. It is curious to note that beekeepers are less prone to cancer than the rest of normal population.

Other uses of honey in addition to aid longevity also have been noted. Some of these uses are: (i) It is used for treatment of asthma (2) As an antibiotic (3) as a food preservative (4) It is also used as a wound salve (a healing ointment to reduce pain).

The value of honey in the treatment of many diseases both internal and external can be traced far back into history.

Composition of honey

Modern science has already discovered a great deal about the composition of honey, but its medical attributes have not yet been accounted for. There are still many of its minor constituents which have not been identified so far. Researchers are doing active work to identify these minor constituents and then value and effects.

We cannot afford to disregard the long historical association between honey and healthy life with longevity. Finally we can say that consumption of pure honey does tremendous good to maintain a healthy and long life.

Coughing may help in a heart attack

Polish doctor claims simple technique works like do-it-Yourself CPR (Cardio Pulmonary Resuscitation)

If you're feeling chest pain and there's no one around to administer CPR should it be needed, remember this: cough. It could save your life, says one researcher at an international meeting of heart specialists.

Tadeusz K. Petelenz, MD, a Polish Cardiologist, is campaigning to convince other heart specialists to back his "Cough-CPR" program.

Petelenz says that most cases of sudden cardiac death - an immediate shut down of the heart - happen in the home (a heart attack, which is brought on by a blocked artery, is the major cause of sudden cardiac arrest, which is an "electrical" malfunction in the heart). By the time help arrives the person is often unconscious, which makes life-saving resuscitation difficult. He says his Cough-CPR can keep the heart functioning long enough for help to arrive.

The mechanical action of the cough acts as a do-it-yourself CPR that delivers needed thumps to the chest, Petelenz says. Those thumps stimulate electrical activity in the heart and keep it beating. To demonstrate the effect, he asked a reporter here at European Society of Cardiology press conference to find her pulse. "Now cough and feel the difference." The journalist said she did "feel" a difference.

Petelenz describes his program this way: the patient is trained to cough everyone to two seconds in bouts of five coughs. This process is repeated in regular morning and evening training sessions until the patient can cough for as many as 10 to 30 coughs in each bout.

But however Leo Bossaert, MD, Executive Director of the European Resuscitation Council and Professor of Medicine at University Hospital in Antwerp, Belgium tells that he is not convinced the Cough-CPR works. He says that the Petelenz study falls short of the scientific standards needed to prove that a treatment works. "We don't know if these patients had true cardiac arrest," he said. Moreover the study didn't include any comparison group so it is unclear if it was the cough that kept the patients conscious or if they would have survived without the cough.

Bossaert says that physiologically Petelenz is correct: cough can be used to keep a patient conscious. "We've been doing this for years in the cath lab," says Bossaert, who explained that sometime patients have cardiac arrest symptoms while undergoing angiography - a dye test used to diagnose blocked heart arteries. When that happens, the doctors tell the patient to cough until the spell passes.

Given the lack of evidence, it would be irresponsible to recommend Cough-CPR training now. He says he also worries that introducing a program like Cough-CPR could confuse the public, which would further delay treatment.

(Sent to health by Ariyasumitra Wijeratne)

******

White blood cells, astral body and astrology

There are some stories of the experiences of men who passed into the very portels of death and were brought back to life by medical treatment.

According to their experiences it seems that they were drawn back into the body after their hearts began to beat strongly. Beating produces electrical activity of the heart and therefore an electro-magnetic field surrounds the heart.

If the astral body consists of white blood cells it can be pulled back to the blood stream by these electro-magnetic waves because the white blood cells are compounds of atoms and can be affected by the electro-magnetic waves.

According to the same theory in a foetus when its heart begins to beat an astral body can be drawned into the foetal blood stream. So the foetal blood should be free of white blood cells before the beginning of its heart beat.

Lifespan of the white blood cells could theoretically be infinitive because under suitable conditions it can grow, divide and produce offspring cells and can be grown even in a tissue culture.

It is possible that the white blood cells enter the foetus as an astral body and spread all over the body through the blood stream. Even today the exult site of processing of the B lymphocyte in man is not known.

A small lymphocyte has the largest nucleus when compared to any other cell in the body of the same size. It is very rich in DNA which forms the genetic code for the transmission of hereditary characters.

If the astral body consists of white blood cells it carries all the hereditary characters from one birth to another.

In Buddhist teaching it is said that the last thought moment of this life perishes conditioning another thought moment in a subsequent life and the new being is neither absolutely the same once it has changed nor totally different being the same stream of 'Kamma' energy which is all moral and immoral volition and intentional action mental, verbal and physical.

As long as this kamma force survives there is re-birth. The body dies and its kammic force is re-born in another life.

Memory cells derived from the lymphocytes which respond positively to the measles virus in childhood may persist throughout one's lifetime. Isn't it possible that these memory cells carry all these thoughts to the subsequent life.

Man is a compound of millions of atoms and cannot remain unaffected by changes in the solar system. Astrology records the influence of planets over the nations, individuals and environment.

IF the astral body consist of white blood cells which are compounds of atoms, it also must be under the influence of the solar system.

Therefore the astral body can find out the suitable mother according to the planetary attractions between itself and the mother.

That is why a skilled astrologer can predict the baby's character to some extent even before it is born according to the planetary influences of mother's birth chart.

Dr.D.P. Alwis, Govt. Hospital Thalathuoya

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